Abstract
Laryngoscopy and tracheal intubation often cause hypertension and tachycardia, which may be exaggerated during rapid-sequence induction of anaesthesia. A placebo-controlled,doubleblind study was conducted in 60 patients to determine doseresponse and effects on myocardial performance of alfentanil when used to attenuate this cardiovascular response. Patients were divided into four groups to receive a pre-induction bolus from a coded syringe, which contained either normal saline (PLAC), alfentanil 30 μg · kg−1 (ALF 30), alfentanil 45 μg · kg−1 (ALF 45) or alfentanil 60 μg · kg−1 (ALF 60). Anaesthesia was induced in rapid sequence with thiopentone 4.0 mg · kg−1 and succinylcholine 1.5 mg · kg−1, and the trachea was intubated 60 sec later. Increases in heart rate (21 ±10 bpm), mean arterial pressure (28 ±13 mmHg), and systemic vascular resistance index (1420 ±780 dynes · sec−1 · cm−5) were observed in response to intubation with PLAC but in none of the 3 ALF groups (P < 0.05). However, heart rate and mean arterial pressure decreased significantly in both the ALF 45 and ALF 60 groups (P < 0.05), whereas ALF 30 resulted in no change in these variables over time. Cardiac index, stroke volume index, and ejection fraction tended to decrease in all four groups, but none of these variables was different at corresponding time when comparing the ALF groups with PLAC. We conclude that ALF 30 μg · kg−1 administered prior to rapid-sequence induction of anaesthesia, effectively attenuates the hypertensive, tachycardic response to intubation, without altering global indices of cardiac function. Alfentanil in doses of 45 and 60 μg · kg−1 result in transient but significant decreases in HR and MAP with this anaesthetic technique.
Résumé
La laryngoscopie et l’intubation endotrachéale souvent amènent l’hypertension et la tachycardie qui peuvent être exagérées lors de l’induction rapide de l’anesthésie. Une étude contrôlée avec un placébo et à double insu a été conduite chez 60 patients afin de déterminer la courbe de dose-réponse et les effets sur la performance myocardique avec l’alfentanil lorsqu’utilisé afin d’atténuer cette réponse cardiovasculaire. Les patients furent divisés en quatre groupes afin de recevoir un bolus en pré-induction d’une seringue codée qui contenait soit du salin physiologique (PLAC), soit de l’alfentanil 30 μg · kg−1 (ALF 30), soit de l’alfentanil 45 μg · kg−1 (ALF 45) ou de l’alfentanil 60 μg · kg−1 (ALF 60). L’anesthésie, avec une séquence rapide d’induction, fut obtenue avec du thiopentone 4,0 mg · kg−1 et de la succinylcholine 1,5 mg · kg−1 après quoi la trachée fut intubée 60 secondes plus tard. L’augmentation de la fréquence cardiaque (21 ±10 bpm), la pression artérielle moyenne (28 ±13 mmHg), et l’index de résistance vasculaire systémique (1420 ±780 dynes · sec−1 · cm−5 I-r · cm−5) fut observé en réponse à l’intubation avec la PLAC mais dans aucun des autres trois groupes ALF (P < 0,05). Cependant, la fréquence cardiaque et la pression artérielle moyenne ont diminué significativement dans les deux groupes ALF 45 et ALF 60 (P < 0,05) alors que dans le groupe ALF 30, aucun changement ne fut observé durant le temps de l’étude. L’index cardiaque, le volume d’éjection indexé et la fraction d’éjection démontraient une tendance à la diminution dans les quatre groupes mais aucune de ces variables n’était différente au temps correspondant lorsque comparée avec les groupes ALF et PLAC. On conclut que l’ALF 30 μg · kg−1 administre avant la séquence rapide d’induction de l’anesthésie a atténué efficacement l’hypertension et la tachycardie en réponse à l’intubation sans altérer les indices globaux de la fonction cardiaque. L’alfentanil à des doses de 45 et 60 μg · kg−1 a amené une diminution significative mais transitoire de la frequence cardiaque et de la pression artérielle moyenne avec cette technique anesthésique.
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Supported by a research grant from Janssen Pharmaccutica (Canada).
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Martineau, R.J., Tousignant, C.P., Miller, D.R. et al. Alfentanil controls the haemodynamic response during rapidsequence induction of anaesthesia. Can J Anaesth 37, 755–761 (1990). https://doi.org/10.1007/BF03006534
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DOI: https://doi.org/10.1007/BF03006534